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Questions and Answers
What is the effect of benzodiazepines on the GABAA receptor?
What is the effect of benzodiazepines on the GABAA receptor?
What is the mechanism of action of barbiturates on the GABAA receptor?
What is the mechanism of action of barbiturates on the GABAA receptor?
What is the effect of benzodiazepines on the serotonergic system?
What is the effect of benzodiazepines on the serotonergic system?
What is the characteristic of benzodiazepines that makes them more desirable than barbiturates?
What is the characteristic of benzodiazepines that makes them more desirable than barbiturates?
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Why are oxazepam and lorazepam preferred in the elderly and in liver dysfunctions?
Why are oxazepam and lorazepam preferred in the elderly and in liver dysfunctions?
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What is the primary difference between an anxiolytic effect and a sedative effect?
What is the primary difference between an anxiolytic effect and a sedative effect?
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Which of the following drugs is a non-benzodiazepine BZ receptor agonist?
Which of the following drugs is a non-benzodiazepine BZ receptor agonist?
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What is the primary mechanism of action of benzodiazepines?
What is the primary mechanism of action of benzodiazepines?
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What is the primary effect of hypnotic drugs at high doses?
What is the primary effect of hypnotic drugs at high doses?
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What is a characteristic of benzodiazepines in terms of their effect on muscle tone?
What is a characteristic of benzodiazepines in terms of their effect on muscle tone?
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Which of the following is NOT a mechanism of action of hypnotic drugs?
Which of the following is NOT a mechanism of action of hypnotic drugs?
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What is a use of diazepam as an anxiolytic?
What is a use of diazepam as an anxiolytic?
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What is a side effect of benzodiazepines when used hypnotically?
What is a side effect of benzodiazepines when used hypnotically?
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What is a characteristic of benzodiazepines in terms of their effects on memory?
What is a characteristic of benzodiazepines in terms of their effects on memory?
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What is a precaution to be taken when using benzodiazepines?
What is a precaution to be taken when using benzodiazepines?
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What is the age limit for the use of diazepam in children?
What is the age limit for the use of diazepam in children?
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What is the mechanism of action of flumazenil in benzodiazepine intoxication?
What is the mechanism of action of flumazenil in benzodiazepine intoxication?
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What is the characteristic of azapiron buspirone?
What is the characteristic of azapiron buspirone?
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What is the duration of action of long-acting barbiturates?
What is the duration of action of long-acting barbiturates?
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What is the effect of barbiturates on spontaneous motor activity?
What is the effect of barbiturates on spontaneous motor activity?
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Which of the following is NOT a treatment option for post-traumatic stress disorder?
Which of the following is NOT a treatment option for post-traumatic stress disorder?
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What is the prevalence rate of insomnia in the population?
What is the prevalence rate of insomnia in the population?
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Which of the following is a sleep hygiene technique for insomnia?
Which of the following is a sleep hygiene technique for insomnia?
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What is the goal of a good sleep pill?
What is the goal of a good sleep pill?
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Which of the following is a cause of insomnia due to medical conditions?
Which of the following is a cause of insomnia due to medical conditions?
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What is the effect of barbiturates on respiratory rate when given in a hypnotic dose?
What is the effect of barbiturates on respiratory rate when given in a hypnotic dose?
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What is the effect of barbiturates on the vasomotor center and myocardium?
What is the effect of barbiturates on the vasomotor center and myocardium?
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What is the use of phenobarbital in the treatment of neonates?
What is the use of phenobarbital in the treatment of neonates?
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What is the interaction between barbiturates and alcohol?
What is the interaction between barbiturates and alcohol?
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What is the effect of barbiturates on bowel motility?
What is the effect of barbiturates on bowel motility?
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What is the primary effect of hypnotic drugs on total sleep time?
What is the primary effect of hypnotic drugs on total sleep time?
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Which of the following hypnotics is suitable for patients who have difficulty maintaining sleep?
Which of the following hypnotics is suitable for patients who have difficulty maintaining sleep?
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What is the maximum duration of use of barbiturates and other types of hypnotics?
What is the maximum duration of use of barbiturates and other types of hypnotics?
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Which of the following drugs does not shorten REM time significantly?
Which of the following drugs does not shorten REM time significantly?
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What is the effect of benzodiazepine receptor agonists on sleep?
What is the effect of benzodiazepine receptor agonists on sleep?
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What is the characteristic of non-benzodiazepine agonists?
What is the characteristic of non-benzodiazepine agonists?
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What is the effect of trazodone on sleep?
What is the effect of trazodone on sleep?
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What is the effect of melatonin on the body?
What is the effect of melatonin on the body?
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What is the effect of valerian on sleep?
What is the effect of valerian on sleep?
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What is the characteristic of non-benzodiazepine agonists in terms of their side effects?
What is the characteristic of non-benzodiazepine agonists in terms of their side effects?
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Study Notes
Anxiolytic, Sedative, and Hypnotic Effects
- Anxiolytic effect: reducing psychomotor reactivity exceeding normal limits to a normal level of attention and responsiveness
- Sedative effect: reducing vigilance and psychomotor reaction ability below normal limits
- Hypnotic effect: inducing sleep
Hypnos Sedative Medications
- Benzodiazepines
- Non-benzodiazepine BZ receptor agonists
- Barbiturates
- Azopyrones (e.g., buspirone, gepiron, ipsapiron) - anxiolytic
- Antihistamines (e.g., hydroxyzine, doxylamine, diphenhydramine, metaprine, promethazine)
- Melatonin, ramelteon
- Others (e.g., aldehydes, propanediol, carbamate derivatives, piperidindiones, quinazolins)
Effects of Hypnos Sedatives
- Dose-dependent and generalized CNS depression
- Drowsiness below sedative dose
- Sedative (anxiolytic) at small doses
- Hypnotic at high doses (narcotic)
- General anesthesia and coma at overdose
- Anticonvulsant and central muscle relaxant effects
Mechanisms of Action of Hypnos Sedatives
- BZ receptors: BZ1 (anxiolytic and sedative), BZ2 (muscle relaxation, CNS depression, and psychomotor changes), BZ3 (located in the SSS and periphery, responsible for tolerance and withdrawal symptoms)
- GABA: agonist (mucimol), antagonist (bicuculin)
- Benzodiazepines: reverse agonists and antagonists (allosteric) on the junction of alpha and gamma subunits of the GABAA receptor
- Barbiturates: allosteric, picrotoxin (blocks the channel directly)
- Ethanol, ivermectin, etomidate, propofol, and gas general anesthetics
Benzodiazepines
- Mechanism of action: activating the binding points (BZ1 and BZ2 receptors) on the GABAA receptor, causing the opening of chloride channels, hyperpolarization, and postsynaptic or presynaptic inhibition
- Interactions with other mediators: affecting the serotonergic system, reducing serotonergic tone, inhibiting the locus coeruleus, suppressing the central cholinergic system, and inhibiting adenosine uptake
- Classification:
- Long-acting (e.g., diazepam, klonazepam, klorazepat, medazepam, flurazepam, kuazepam)
- Medium-acting (e.g., oxazepam, alprazolam, lorazepam, temazepam, nitrazepam, flunitrazepam)
- Short-acting (e.g., midazolam, triazolam)
Properties of Benzodiazepines
- Lipophilic
- Quickly absorbed from the GI canal
- Elimination half-life varies from person to person, influenced by age
- Preference for oxazepam and lorazepam in the elderly and liver dysfunctions
- Metabolized by CYP 3A4 and CYP2C19, excreted in the form of conjugates
- Long-acting benzodiazepines: no long effects when used in a single dose, requiring 5-14 days of treatment for a significant effect
- Short- and medium-acting benzodiazepines: greater potential for physical addiction and risk of amnesia
Uses of Benzodiazepines
- Anxiety disorders (e.g., panic reactions, phobias)
- Sleep disorders
- Induction of general anesthesia and short-term surgical or diagnostic interventions
- Anticonvulsants (e.g., clonazepam, midazolam, nitrazepam, triazolam)
- Striated muscle rigidity and spasm, nocturnal myoclonus, athatosis
- Tetanus, febrile convulsion, status epilepticus, and withdrawal syndrome
Side Effects of Benzodiazepines
- Drowsiness, mental and psychomotor dysfunction
- Impaired motor coordination, ataxia, nystagmus, drunken speech
- Anterograde amnesia, dementia
- Disruption in jobs that require skill
- Headache, dizziness, nausea, vomiting
- Decreased visual acuity, joint pain
- Addiction: physical dependence occurs without significant psychic dependence in use for more than 6 weeks
Azapirones
- Partial agonist at serotonergic receptors of type 5HT1A
- Reduces serotonergic activity in the limbic system
- No hypnotic effect, no tolerance, and non-addictive
- Superiority over benzodiazepines: fewer psychomotor disorders, less sedation and amnesia, no interaction with alcohol, and no tolerance and dependence with benzodiazepines and other sedatives
Barbiturates
- Classification by duration of action:
- Long-acting (e.g., phenobarbital, sedative and anticonvulsive)
- Medium-acting (e.g., pentobarbital, allobarbital, amobarbital, hypnotic, butalbital, siklobarbital)
- Short-acting (e.g., sekobarbital, hexobarbital)
- Very short-acting (e.g., thiopental, IV anesthetic)
- Pharmacokinetic properties: quickly absorbed through the GI duct, absorbed and used through the rectum, IM absorption is quick, easily passes into milk
- Pharmacodynamic properties: sedative and hypnotic effect, anticonvulsant effect, general anesthesia
Side Effects of Barbiturates
- Drowsiness and residual effect
- Impaired cognitive functions in infants and children
- Dependence and tolerance
- Rebound insomnia
- Allergic reactions, respiratory depression, paradoxical excitation
- Exacerbation of porphyria, local pain, and myalgia
Drug Interactions
- Additive interaction with other anxiolytic and hypnotic drugs
- Alcohol potentiates the effects of barbiturates
- Induction of microsomal enzymes (CYP3A4, CYP2C9) and reduced plasma levels of drugs metabolized by these enzymes
Acute Barbiturate Poisoning
- Symptoms: excessive drowsiness, confusion, slurred speech, decreased respiratory rate, sometimes rapid and superficial breathing
- Treatment: respiratory support, prevention and treatment of shock, maintenance of renal function, forced diuresis, peritoneal dialysis, hemodialysis
Other Hypnosedative Drugs
- Dexmedetomidine: central sympatholytic, sedative, and analgesic effects
- Agomelatine: MT1 and 2 and 5-HT2C receptors
Anxiety Disorders
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
- Post-traumatic stress disorder
- Obsessive-Compulsive disorder
Basic Sleep Disorders
- Insomnia
- Sleep breathing disorders (e.g., obstructive sleep apnea syndrome)
- Excessive sleepiness that is not due to breathing disorder during sleep (e.g., narcolepsy, hypersomnia)
- Circadian rhythm disturbances
- Parasomnias (e.g., making the patient's environment safe, MAO inh, alcohol and caffeine restriction)
- Sleep-related movement disorders (e.g., restless legs syndrome)### Sleep-Related Movement Disorders
- Elimination of iron deficiency, dopamine agonists, benzodiazepine, carbamezapine, and gabapentin can be used to treat sleep-related movement disorders
Insomnia
- Insomnia is characterized by difficulty falling asleep, difficulty maintaining sleep, frequent awakenings, and early awakening
- Its prevalence in the population is between 30-40%, and it accounts for 50-80% of all sleep disorders
Sleep Hygiene
- Getting up at the same time every morning
- Ensuring consistent bedtime and removing daytime sleeps
- Exercising regularly, but avoiding physically strenuous activities until 3-4 hours before bedtime
- Creating a sleep-conducive environment with minimal noise, light, and heat
- Avoiding eating close to bedtime (up to 2 hours before bedtime)
- Avoiding caffeine, alcohol, cola drinks, and tobacco use at least 6 hours before bedtime
- Not forcing oneself to sleep in bed when unable to sleep at night
- Using relaxation techniques such as breathing exercises before bed
Sleep Periods
- A good sleep pill should reduce the REM pattern and duration of REM without changing the total sleep time
- Hypnotic drugs shorten the time it takes to fall asleep and some shorten REM time significantly
- Short-acting hypnotics are suitable for those who have difficulty falling asleep
- Medium-duration hypnotics are suitable for those who have difficulty starting and maintaining sleep
- Hypnotics with a long duration of action are suitable for those who wake up early in the morning and have anxiety during the day
Pharmacological Treatment of Insomnia
- Benzodiazepine Receptor Agonists (estazolam, flurazepam, quazepam, temazepam, triazolam) shorten the time to sleep, prolong total sleep time, reduce wakefulness, and prolong NREM
- Non-benzodiazepine agonists (Zopiclone, Eszopiclone, Zolpidem, Zaleplon, Indiplon) bind to GABA A receptors and have weaker muscle relaxant and anticonvulsant effects
- Antidepressants (trazodone, mirtazapine, amitriptyline) increase deep sleep and do not shorten REM
- Antihistamines (diphenhydramine, hydroxyzine, doxylamine) can be used to treat insomnia
- Melatonin and ramelteon (MT1 and 2 receptor agonist) regulate the sleep-wake cycle and can treat jet lag
- Valerian (Valeriana officinalis) makes it easier to fall asleep and regulates GABAa receptors
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Description
Learn about anxiolytic, sedative and hypnotic effects of drugs, including their definitions and effects on psychomotor reactivity and vigilance.